Why is codeine prescription only?

For most people, OTC medicines containing codeine provide very little extra pain or coughing relief, compared with medicines that do not contain codeine.

Codeine use has serious risks:

Tolerance: where higher and higher doses are needed to feel the same relief from symptoms.

Withdrawal symptoms: where symptoms such as head and muscle aches, mood swings, insomnia, nausea and diarrhoea occur when the medicine is stopped. People can be confused by these symptoms and think they need to take the codeine-containing medicine for longer or in higher doses.

Because codeine is combined with other medicines in OTC products, poisoning can result from taking more than the recommended dose of the other active ingredients (eg, paracetamol or ibuprofen) in the combination medicine.

High doses or long-term use of paracetamol can result in liver damage. Long-term ibuprofen use can lead to internal bleeding, kidney failure and heart attack.

What can I do if I can't get my usual medicine?

There are over-the-counter medicines without codeine that can help to manage acute pain or the symptoms of a cough or cold. Some medicines may contain a single active ingredient, others may contain two or more, such as combination paracetamol and ibuprofen for stronger pain relief.

Talk to your pharmacist

Pharmacists are an important source of information and advice for you. They will be able to advise you on the most appropriate alternative OTC medicines.

It is very important to speak with a pharmacist if you have any other medical conditions, such as stomach, kidney, liver or heart problems.

Talk to your doctor

If you have ongoing pain, you should talk to your doctor or health professional to find out about alternative treatment options. These may include:

alternative OTC or prescription medicines

non-medicine therapies from an allied health professional, such as a physiotherapist

self-management tools, such as exercise or relaxation

referral to a pain specialist or pain management clinic.

Ask your doctor about a Medicare-funded care plan that will provide a rebate for treatment from an allied health professional. If your doctor prepares a Chronic Disease Management (CDM) Plan or a Team Care Arrangement (TCA), you may be eligible for Medicare benefits towards the cost of services such as physiotherapy.

If you think that you are unable to manage without codeine or have experienced any side effects of withdrawal, speak with your doctor or a trusted health provider about the types of support available for you.

Managing pain without codeine

Find out more about pain and how to manage it safely with our resources on:

Headaches and how to treat themHeadache affects nearly everyone at some point in their life. Understanding which type of headache you have will help you make an informed choice about your care.

Chronic pain explainedIf you have chronic pain, you are not alone. One in five Australians, including children and adolescents, lives with chronic pain, but this number rises to one in three for those over the age of 65. Chronic pain is usually defined as constant daily pain that is present for at least 3 of the preceding 6 months. Chronic pain can have many causes but it can also have no diagnosable cause.

Managing period painPeriod pain is one of the most common health issues for women. Period pain refers to pain in the lower abdomen which can occur just before or during a woman’s period, usually lasting for around two to three days. The severity of period pain varies between women; from a mild annoyance to severe pain which can interfere with normal day-to-day activities.

Managing migraineMigraine is not just another word for ‘bad headache’. Specific characteristics distinguish them from tension-type headaches. Migraines affect about 1 in 10 people, particularly women. Minimising potential migraine triggers plays an important role in managing migraine. In addition, different medicines can be used as preventive therapy for migraine.

Treating my child’s pain or fever - paracetamol or ibuprofen?Ibuprofen and paracetamol are two of the most commonly used over-the-counter (OTC) medicines to treat pain and fever in children. However, they differ in many ways, from how they work and who can take them, to their risk of side effects and interactions with other medicines.

Codeine access for rural and remote Australians

Ask your pharmacist

Most people should be able to manage their short-term (acute) pain or cough and cold symptoms with other medicines that don't contain codeine. These medicines are available at your local pharmacy without a prescription and are known as 'over-the-counter' medicines. Your pharmacist or other health professionals will be able to provide advice on the most appropriate medicines for you.

Talk to your doctor or nurse practitioner

Formerly available over-the-counter codeine-containing medicines were only intended to treat short-term (acute) pain and not long-term (chronic) pain.

If you have ongoing (recurrent, persistent or chronic) pain you should talk to your pharmacist, doctor or nurse practitioner about the best way to manage your pain. These health professionals can determine the best course of treatment for you, which could include non-medicine therapies, such as treatment from a physiotherapist or self-management tools such as exercise or relaxation.

Your health professional can also provide information and referrals if they feel you may require extra help to manage your chronic pain. This referral could to be to a specialist near you or via a service called Telehealth that is funded by the Department of Health. This service gives Australians living in rural and remote areas greater access to a range of specialists.

Telehealth services use information and communication techniques (such as video conferencing) to deliver health services across Australia without the need for travel.

Prescribing by registered nurses

In some areas, remote area nurses and registered nurses can prescribe codeine-containing medicines under specific circumstances.

Phone advice

For free health advice 24 hours, 7 days a week, you can call Healthdirect Australia on 1800 022 222. Healthdirect is able to provide you with advice on all health topics, including pain management in acute or chronic situations.

Date published: 15 August 2017Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise disclaims all liability (including for negligence) for any loss, damage or injury resulting from reliance on or use of this information. Read our full disclaimer. This website uses cookies. Read our privacy policy.